Revamping Medical Store Procurement to Reduce Out-of-Pocket Expenses in West Bengal

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West Bengal Government's initiatives aim to reduce out-of-pocket patient expenses by revamping medical store procurement, establishing fair price medicine shops, and promoting generic medicines. Challenges include high reliance on public healthcare facilities and limitations of the free distribution scheme. The government is addressing these challenges by strengthening the distribution scheme, setting up fair price medicine shops, and promoting the prescription of generic medicines by doctors.

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INITIATIVES TO REDUCE INITIATIVES TO REDUCE OUT OF POCKET PATIENTS THROUGH PATIENTS THROUGH REVAMPED MEDICAL STORE PROCUREMENT REVAMPED MEDICAL STORE PROCUREMENT, , FAIR PRICE MEDICINE SHOPS FAIR PRICE MEDICINE SHOPS AND AND INCREASED PRESCRIPTION OF GENERIC MEDICINES GENERIC MEDICINES OUT OF POCKET EXPENDITURE OF EXPENDITURE OF INCREASED PRESCRIPTION OF HEALTH & FAMILY WELFARE DEPARTMENT HEALTH & FAMILY WELFARE DEPARTMENT GOVERNMENT OF WEST BENGAL GOVERNMENT OF WEST BENGAL

CHALLENGES (1) CHALLENGES (1) People in West Bengal largely depend on public health care system run by the State Government. The Government Healthcare Facilities take approximately 78% of the total patient load of the state. On an average, footfalls in Govt hospitals per year are of the order of 100 million.

CHALLENGES (2) CHALLENGES (2) Free distribution scheme has limitations, can not cover all the needs of the patients for drugs etc Public perception regarding quality of drugs available under free distribution scheme has not been good Facilities of Free Scheme not available round the clock Availability of Implants used in Medical Colleges (e,g Cardiac/Orthopedic Implants) at affordable rates continues to be major issues for the patients

CHALLENGES (3) CHALLENGES (3) Due to inherent limitations of free scheme, patients are dependent to a large extent on the retail pharmacies operating outside the Hospitals to procure branded medicines prescribed by the Doctors at market rates (MRP rates) The state government has no control over price and quality of these medicines procured from private retail pharmacies other than routine checks by Directorate of Drugs Control,

Initiatives taken to meet these challenges Initiatives taken to meet these challenges A. Strengthening of Free Distribution Scheme for Medicines & Consumables. B. Establishing Additional Delivery System of Medicines, Consumables etc at affordable cost round the clock through a chain of Fair Price Medicine Shops (FPMS) within the hospitals. C. Encouraging Prescription of Medicines in Generic Names by Doctors of Government Hospitals

A. STREGTHENING OF FREE DISTRIBUTION SCHEME for MEDICINES & CONSUMABLES (1) Significant increase in the Budgetary allocation from Rs 157 crore in 2011-12 to Rs. 287 crore and Rs 304 crore during 2012-13 and 2013-14 respectively. e-Procurement of Medicines & Consumables using NIC portal ensuring transparency in the procurement process. Departing from previous practice, only Manufacturers having adequate market presence are permitted to participate in tender process. Reducing number of suppliers to a manageable level by changing the earlier system for better monitoring of delivery status and quality control over drugs received

STREGTHENING OF FREE DISTRIBUTION SCHEME for MEDICINES & CONSUMABLES (2) Empanelment of a number of Drug Testing Laboratories accreditated Labs across the Country including NABL Results of Quality Testing shared with the Hospital Authorities, thus helping to build confidence of the Doctors in the Hospital on quality of medicines under free scheme Adequate penal measures included in the agreement with the suppliers

STREGTHENING OF FREE DISTRIBUTION SCHEME for MEDICINES & CONSUMABLES (3) Installation of a dedicated web enabled soft ware on Store Management Information System (SMIS) for participants including authorities for all transactions decentralized procuring The system does not allow generation of delivery order unless matching fund is available, which is allocated and entered in the system centrally The system does not allow further procurement of an item when there is adequate (25% of annual requirement) stock of that item. Distribution of drugs to peripheral units done by decentralized stores through SMIS on FIFO Basis

STREGTHENING OF FREE DISTRIBUTION SCHEME for MEDICINES & CONSUMABLES (4) A Vendor portal has been created for the vendors to information regarding issued, delivery status of bill and payment status. provide on line order supply This has ensured transparency and accountability

OUTCOMEOF THE REFORMS BROUGHT TO FREE DISTRIBUTION SCHEME Increased availability of Medicines in hospital pharmacies Procurement of Better Quality of Medicines Enhanced confidence of Patients and Doctors on drugs under free scheme due to improved quality & availability of drugs Transparency established and accountability has been Vendor portal, e-tender and e- payment has attracted participation of reputed manufacturer to tender process.

CONSOLIDATING THE GAINS OF FREE DISTRIBUTION SCHEME WITH THE SUPPORT OF NATIONAL HEALTH MISSION (NHM) INTEGRATION OF THE FREE DRUG SERVICE SCHEME UNDER NHM IN THE EXISTING FREE DISTRIBUTION SCHEME OF THE STATE The state government fulfills eligibility criteria of the scheme under NHM as under 1. Essential Drugs are provided free to all OPD patients in the state run hospitals 2 Procurement, Delivery and Quality Control System of Drugs are all IT backed

CONSOLIDATING THE GAINS OF FREE DISTRIBUTION SCHEME WITH THE SUPPORT OF NATIONAL HEALTH MISSION (NHM) [2] INTEGRATION OF THE FREE DRUG SERVICE SCHEME UNDER NHM IN THE EXISTING FREE DISTRIBUTION SCHEME OF THE STATE 3. Procurement under existing free scheme is made using Inventory Control Guidelines that places Drugs under Three Categories, viz, Vital, Essential and Desirable The proposed scheme under NHM will further augment the resources for distribution of drugs to all patients free of cost

B B. Additional Delivery System of Medicines & Consumables at affordable cost through a chain of Fair Price Medicine Shops under PPP Even after reform, the scheme for free distribution of drugs at Government Hospitals has limitations. With fixed budget, it can not meet all the requirements of patients visiting the hospitals. Hospital Pharmacies do not operate on 24x7 basis although 24x7 Emergency Services exist in Hospitals. It was felt necessary for creating a secondary source of supply outlets under PPP mode to ensure round the clock availability of products at pre approved discounted rates over the MRP, much lower than the market price

Additional Delivery System of Medicines & Consumables 24 Hours at affordable cost through a chain of Fair Price Medicine Shops.

Additional Delivery System of Medicines & Consumables 24 Hours at affordable cost through a chain of Fair Price Medicine Shops.

Additional Delivery System of Medicines & Consumables 24 Hours at affordable cost through a chain of Fair Price Medicine Shops for the benefit of the patients In the first phase, 34 such outlets, out of 35 planned, have become functional covering all the Medical Colleges, most of the District Hospitals and selected SD Hospitals between Dec 2012 and June 2013 In the second phase another 52 outlets would be set up during 2013-14. The selection of Private Partners is underway. Clearly defined and transparent process of selection of private partners have been followed. The bidding parameter for selection of private partner was the maximum discount on MRP for each hospital offered by the technically qualified applicants

Fair Price Medicine Shops (FPMS) for the benefit of the patients Products and Services available at FPMS 142 mandatory generic medicines as per list provided in the scheme. This list is dynamic. Medicines listed under the guidelines of JSSK The FPMS is also enlisted under RSBY scheme Additional Medicines (Branded/Generic) over 142 items to meet the needs of patients. Medical Consumables with mandatory list of 39 items along with surgical items. Orthopaedic & Cardiology related devices/implants used in in higher tier hospitals (e. g Cardiac Stents)

Fair Price Medicine Shops (FPMS) for the benefit Fair Price Medicine Shops (FPMS) for the benefit of the patients of the patients QUALITY ASSURANCES QUALITY ASSURANCES Quality and other important parameters for the manufacturers to be followed by the private partners for procurement of stocks have been incorporated in the agreement signed with the private partner. Other measures include quality audits for randomly selected samples from these outlets undertaken by competent authority. A protocol for quality audit of drugs procured and sold by the FPMS has been introduced.

Fair Price Medicine Shops (FPMS) for the benefit Fair Price Medicine Shops (FPMS) for the benefit of the patients of the patients MONITORING MECHANISM MONITORING MECHANISM Approved software package installed in these outlets for day to day transactions including sales, inventory, stock outs etc. The programme is being connected with the concerned hospital as well as with Swasthya Bhawan for on line tracking of sales and inventory. State chairmanship of Director, Medical Education have been formed for this scheme. Similarly monitoring committee formed at each of the hospitals having FPMS outlet level monitoring committee under the

Fair Price Medicine Shops (FPMS) Fair Price Medicine Shops (FPMS) OUTCOME (BENEFITS FOR THE PATIENTS) OUTCOME (BENEFITS FOR THE PATIENTS) Discounts ranging from 48% to 67.25% on MRP are available in different hospitals under this scheme for all items providing immense benefits for the patients Initial sales indicate overwhelming response of patients and acceptability by hospital doctors for medicines sold from FPMS. This means huge reduction of out of pocket of expenses of patients. Till 31st May 2013, in five months time, Gross sales, Discount availed by patients and number of patients benefitted are Rs. 34.65 crore, Rs.20.94 crore and 11.04 lakh respectively.

Fair Price Medicine Shops (FPMS) Fair Price Medicine Shops (FPMS) OUTCOME (Performance Trend) OUTCOME (Performance Trend) 14 12 Gross sales (Rs in cr) 10 8 Discounts (Rs in cr) 6 No. of patients(in lakh) 4 2 0 Feb/13 Mar/13 Apr/13 May/13

C. ENCOURAGING PRESCRIPTION IN GENERIC NAME BY DOCTORS OF GOVERNMENT HOSPITALS The instructing Doctors for prescriptions in Generic Name to help patients procure drugs free of cost from hospital pharmacies or to procure the same from FPMS at much economical rates Prescription audit has been initiated with the support of the Experts of the Department to ascertain rational use of drugs and extent of prescriptions in Generic Name State Government has issued Order OUTCOME NOTICEABLE iNCREASE IN THE PRESCRIPTIONS IN GENERIC NAME BY DOCTORS ESPECIALLY IN LAST TWO TO THREE MONTHS

CONCLUSION INITIATIVES TAKEN IN IMPROVING DELIVERY SYSTEM OF QUALITY DRUGS & CONSUMABLES IN GOVERNMENT HOSPITALS THROUGH STRENGTHENING OF FREE DISTRIBUTION SCHEME CREATING A SECONDARY SOURCE OF SUPPY AT AFFORDABLE COST FROM FAIR PRICE MEDICINE SHOPS THROUGH PPP AND ENCOURAGING PRESCRIPTIONS IN GENERIC NAME BY DOCTORS OF GOVERNMENT HOSPITALS ARE SHOWING POSITIVE OUTCOME AS IS EVIDENT FROM THE PERFORMANCE TREND IN TERMS OF BENEFITS TO THE PATIENTS